Original Article MULTIDRUG RESISTANT TYPHOID FEVER IN EGYPT

Introduction: Typhoid fever is a global health problem, with an estimated 20 million cases and 700.000 deaths annually. In Egypt, since the beginning of the 1980s, there has been an increase prevalence of multidrug resistance to the fi rst line antimirobials, such as chloramphenicol, ampicillin and trimethoprim-sulfamethoxazole (TMP-SMX), shifting the drug of choice for the treatment of typhoid fever to fl uoroquinolones and third generation cephalosporins. Aim of the Study: was to detect if multidrug resistant (MDR) typhoid fever is still a problem in Egypt after two decades of its widespread. Also, we studied if resistance had appeared to quinolones and third generation cephalosporins which were widely used for treatment of typhoid fever in the last fi fteen years. Patients and Methods: In the period between March 2006 and March 2007, thirty seven patients with positive blood culture for Salmonella typhi were included in this study. They were 23 (62%) males and 14 (38%) females with age range from 3 to 45 years (mean 19 ± 8.2 years). Results: Drug sensitivity tests showed that 34 (92%) of Salmonella typhi isolates were sensitive to chloramphenicol and 24 (65%) and 23 (62%) isolates were sensitive to ampicillin and TMPSMX, respectively. Only one (3%) isolate was MDR to chloramphenicol, ampicillin and TMP-SMX. All isolates were sensitive to ciprofl oxacin and ceftriaxone. Forteen (38%) patients were treated with chloramphenicol and twenty three (62%) patients were treated with ceftriaxone. All patients were cured. The mean time of defervescence for ceftriaxone and chloramphenicol was 3.7±1.2 and 5.8±1.2, respectively. Ceftriaxone was signifi cantly associated with a shorter time of defervescence compared with chloramphenicol. Conclusion: There is marked reduction of prevalence of MDR Salmonella typhi isolates and marked increase of susceptibility of these isolates to chloramphenicol, returning it to be one of the drugs of choice for treatment of acute typhoid fever. No drug resistance to ceftriaxone and ciprofl oxacin was reported after many years of using for treatment of acute typhoid fever. Ceftriaxone was signifi cantly associated with short time of defervescence making it the drug of choice for treatment of severe and complicated cases of typhoid fever. Due to high degree of resistance to ampicillin and TMP-SMX they should not be used as fi rst line drugs for treatment of acute typhoid fever.